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Obstetrical Anesthesia and Dwarfism; a case series
Abstract Number: F-39
Abstract Type: Case Report/Case Series
Dwarfism is a catch all term for patients with acquired genetic mutations leading to short statures1. Cesarean section is the most recommended method of delivery in pregnant patients with dwarfism. There is no standard of care for the mode of anesthesia i.e. general anesthesia versus regional anesthesia during cesarean section in this group of patients. Acceptable outcomes have been reported by either of these methods, although general anesthesia has been used more frequently. GA has tended to be favored in the management2 of these cases due to cardiopulmonary issues and worries about spinal cord/column syndromes1. However, given the prevalence of obstructive sleep apnea, atlanto-axial instability, and airway management issues underlying both dwarfism and the pregnant state make a RA favored by some1,3. We report the details of anesthetic methods and relevant clinical outcomes in a cohort of patients with dwarfism who underwent c/s in our unit.
Materials and Methods
We reviewed the anesthetic charts of 7 patients with a number of known and unknown genetic mutations leading to dwarfism. These patients underwent c/s in our unit from Feb 2012 to July 2015. Demographic data, mode of anesthesia, comorbidities and other obstetrics parameters were reviewed.
All patients were seen by a senior anesthesiologist with a detailed plan in place. All of the patients underwent c/s. Five of patients successfully received RA, 4 CSE technique and one single shot spinal anesthetic. Two patients underwent planned GA. Details and patients demographics are listed in table below.
This case series demonstrates that dose controlled RA is a safe mode of anesthesia for patients with dwarfism. A multi-disciplinary team of physicians and healthcare professional including maternal and fetal medicine group were involved in the decision-making and coordination of a cohesive plan for each patient. Pre-operative planning in certain cases were GA is required is of paramount importance.
1. Berkowitz et al. Dwarfs: Pathophysiology and Anesthetic Implications. Anesthesiology. 73. 739-759
2. Walts LF, Finerman G, Wyatt GM. Anaesthesia for dwarfs and other patients of pathological small stature. Can Anaesth Soc J. 1975;22:703-9
3. Brimacombe JR, Caunt JA. Anaesthesia in a gravid achondroplastic dwarf. Anaesthesia. 1990;45: 132-4.